| Objective:Our study was aimed to explore the psychological status, illness perception, health seeking behavior, and the doctor-patient relationship (DPR) of patients with functional gastrointestinal disorders (FGIDs). We expected to find a starting point to improve their quality of life and their relationship with doctors, as well as to provide potential indicators to assess the illness severity and prognosis.Methods:our study was comprised of three parts. The first part recruited functional dyspepsia (FD) patients consecutively. The Composite International Diagnostic Interview 3.0 and the FGIDs Rome Ⅲ diagnostic questionnaire were employed to ensure the diagnoses of mental disorders and FGIDs respectively. The Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), and the 36-item Short Form Health Survey were used to assess the severity of depression, anxiety, and health-related quality of life (HRQoL). FGIDs patients were included in the second part, and patients with peptic ulcer (PU) or reflux esophagitis (RE), patients with major depressive disorders (MDD), as well as general patients (GP) in traditional Chinese medicine or general internal medicine departments were equally included as comparison. The Chinese version of Illness Perception Questionnaire-revised (IPQ-R), the Depressive Symptom Severity Scale of patient health questionnaire (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), and the 12-item Short Form Health Survey (SF-12) were employed to measure the symptoms identity, illness representation and causes, depression, anxiety and HRQoL. The last part was a multi-centered cross-sectional study, which recruited patients with multiple somatic symptoms [the total score of the somatic symptoms severity scale (PHQ-15)≥10)] from the gastrointestinal outpatients departments in Beijing, Shanghai, and Chengdu. The Patient-Doctor Relationship Questionnaire (PDRQ) and the Difficult Doctor Patient Relationship Questionnaire (DDPRQ) were used to measure the DPR from patients’ and doctors’ perspectives respectively.Results:1. The first part of our study included 75 FD patients, in which 42.7%(32/75) were comorbid with MDD.1) there was high overlap between FD and other types of FGIDs (76.0%), as well as any type of mental disorders (49.3%); 2) FD patients had high level of depression and anxiety, while the HAMD scores (22.2±8.1 VS 14.4±7.5,p<0.001) and HAMA scores (21.9±9.4 VS 14.9±7.4, p=0.001) of those with MDD comorbidity were significantly higher than those without; 3) the HRQoL of FD patients were lower than the general population, while those with MDD comorbidity were even worse in terms of both the physical composite score (PCS) (43.2±18.0 VS 57.0±20.7, p=0.004) and the mental composite score(MCS) (30.5±23.4 VS 54.9±26.7,p<0.001); 4) only 52.6% FD patients thought they had got clear diagnoses.43.9% FD patients were satisfied with their diagnoses and explanation.53.6% FD patients were not satisfied with their treatment. Regarding these aspects, no significant difference was detected between FD patients with or without MDD.2. The second part of our study recruited 499 patients.102 of them belonged to the FGIDs group,95 to the PU/RE group,100 to the MDD group, and 202 to the GP group. 1) in terms of the symptoms identity,90.0% MDD patients and 80.2% GP patients had gastrointestinal symptoms, while 96.1% FGID patients also had extra-intestinal symptoms; 3) regarding the illness representation, comparing with other three groups of patients, FGIDs patients expected their illnesses as with more negative consequences (18.4±4.7) and had higher emotional representation (20.2±4.9), while their personal control (19.1±3.8), treatment control (17.6±2.6) and illness coherence (14.0±3.6) scores were the lowest; 4) the illness perception of negative consequences (β=-0.6), pain symptoms identity (β=-5.6), high culture-specific attribution (β=-0.3), the PHQ-9 total score (β=-0.3), and the number of doctor visiting (β=-0.8) were independent risk factors for PCS.37.3% of the total variance could be explained by this model (F=41.6, p<0.001), and the negative consequences could explained 22.0%. The PHQ-9 total score (β=-0.58), depressive symptoms identity (β=-6.75), high emotional representation (β=-0.26), psychological attribution (β=-0.24) and the GAD-7 total score (β=-0.41) were independent risk factors for MCS.58.6% of the total variance could be explained by this model (F=41.6, p<0.001), and the PHQ-9 total score could explained 50.6%.3.139 outpatients in gastrointestinal (GI) departments were recruited in the third part of our study, in which 47.5%(66/139) were SOM+.1) the severity of somatic (13.6±3.5 VS 5.0±2.8, p<0.001), depressive (10.7±5.5 VS 6.4±6.1, p<0.001) and generalized anxiety (7.5±4.9 VS 4.4±4.9, p<0.001) symptoms of SOM+patients in GI departments were significantly higher than the control group; 2) SOM+patients in GI departments had dysfunctional cognitive, emotional and behavioral characteristics, including catastrophising of physical sensation (59.0%VS 40.9%,p=0.041), rumination (31.1% VS 15.4%, p=0.036), somatic illness beliefs (47.5% VS 21.2%, p=0.002), illness/health worries (67.2% VS 48.5%,p=0.033), vulnerability (50.8% VS 27.3%,p=0.006), negative self-concept of bodily weakness (41.0% VS 21.2%, p=0.016), avoidance of physical activities (47.5% VS 25.8%, p=0.011), and inability to tolerate symptoms (78.3% VS 53.0%, p=0.003); 3) the PDRQ total scores of SOM+patients were significantly lower than their comparison (38.8±7.7 VS 41.1±5.9, p=0.048), and the DDPRQ total scores were significantly higher (23.8±6.7 VS 20.9±7.0, p=0.016). SOM+patients were significantly less satisfied than their comparison in terms of trusting their doctors (4.0±0.8 VS 4.3±0.6,p=0.024) and being satisfied with their treatment (3.8±1.1 VS 4.1±0.8,p=0.030). Doctors experienced SOM+patients as more difficult in terms of being frustrated by their vague complaints (2.8±1.3 VS 2.1±1.1,p=0.001) and the patients’self-destruction (1.8±1.1 VS 1.5±0.8,p=0.040); 4) the PHQ-9 total scores were the independent predictor for both the PDRQ and DDPRQ total scores.Conclusions:1.49.3% FD patients were comorbid with mental disorders.2. GI symptoms had been widely detected in general hospital outpatients, while extra-intestinal symptoms were also universal in FGIDs patients.3. FGIDs patients and SOM+patients in GI departments had significant negative illness perception, and dysfunctional cognitive, emotional and behavioral characteristics. Compared with the control groups, they had higher level of depression and anxiety, worse HRQoL, and less satisfaction with their diagnoses and treatment.4. Rrecognizing and adjusting the negative cognition, as well as managing the extra-intestinal symptoms and comorbid psychological problems could be helpful to improve the HRQoL of FGIDs patients.5. Both SOM+patients and their doctors in GI departments experienced their DPR as worse than the control group. To improve the DPR with them, doctors need to make more clear and definite diagnoses and explanation, as well as to identify and manage the potential psychopathology. |
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